LETTERS: MEDICARE'S CODES ADD TO CONFUSION

To the editor:

The Jan. 22 editorial, "Medicare misinformation is confusing," was more confusing that the issue you addressed. You suggest the United Seniors Association mailing informing Medicare patients of the change in law "appears to be incorrect." You further state the number of affected patients is very small.

I believe the new law is troubling. The Health Care Financing Administration, which administers Medicare, is more troubling. HCFA is using a straight and narrow interpretation, which means everyone on Medicare and every doctor now accepting Medicare is affected.

Many medical procedures, and most outpatient surgery, must be pre-approved by Medicare. Frequently this approval is initially denied until more information is obtained. Partial approval is common. Previously a Medicare patient could undergo the procedure, submit the additional information and pay the difference. Now the procedure is delayed. What if it's life-threatening? What about doctors who do not accept assignment -- the amount approved by Medicare? If the patient pays the difference, is the doctor punished? The new law calls for a fine, prosecution or a two-year Medicare exclusion.

Let me tell you about my 1997 flu shot. Medicare spent tens of thousands of dollars publicizing it would pay for flu shots. My doctor's nurse gave me the shot and filed with Medicare under the code for miscellaneous injections. Medicare refused to pay, so I paid. The new law would mean a two-year exclusion. Other doctors filed claims for flu shots under the code for the serum used, not the shot. Medicare paid $3.35. Some doctors filed under the code for the doctor giving the shot, and Medicare refused payment. Has any doctor given you a shot in the past 20 years? Nurse yes. I don't believe a code exists for nurses giving shots. Medicare probably uses $150 in administration fees to pay $3.35 for flu serum and then hides behind confusing codes. I'm sure there is some fraud and abuse, but the big waste of tax dollars is Medicare administrative fees. Now Medicare has been elevated to dictator status, which will only further complicate the confusing medical codes.

Medicare interprets laws as it desires, similar to the IRS procedure. U.S. Sen. John Ashcroft says he is attempting to correct the new law, which is not an exaggerated or misrepresented problem. Ashcroft writes that the law "effectively restricts the ability of Medicare beneficiaries to enter into private contracts with their physician of choice." He adds, "Clearly, this is an example of federal bureaucrats arrogantly believing they know better than America's seniors when it comes to making health-care decisions."

This new law clearly affects all doctors and Medicare beneficiaries. It's a shame our elected leaders supported this law.

RON DEAN

Chaffee